Title Page
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Inspection Date
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SCR Number where Task is to be completed
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Client Site where Task is to be completed
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Job / Task
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Technician
Take 5
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Am I fit to preform the task (aware, rested and alert)?
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* You have selected "NO' to one of the first 5 questions. Do not proceed with work until you can answer yes by putting controls in place. If in Doubt contact your Supervisor. ***YOU ARE NOT AUTHORISED TO BEGIN WORK****
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Controls are now in place
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Have I walked through and assessed the the area before commencing the task
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* You have selected "NO' to one of the first 5 questions. Do not proceed with work until you can answer yes by putting controls in place. If in Doubt contact your Supervisor. ***YOU ARE NOT AUTHORISED TO BEGIN WORK****
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Controls are now in place
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Am I using the correct tools / PPE for the task?
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* You have selected "NO' to one of the first 5 questions. Do not proceed with work until you can answer yes by putting controls in place. If in Doubt contact your Supervisor. ***YOU ARE NOT AUTHORISED TO BEGIN WORK****
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Controls are now in place
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Have I put all SAFE Controls in Place to ensure that I dont breach a Cardinal Rule
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* You have selected "NO' to one of the first 5 questions. Do not proceed with work until you can answer yes by putting controls in place. If in Doubt contact your Supervisor. ***YOU ARE NOT AUTHORISED TO BEGIN WORK****
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Controls are now in place
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Do I know what to do in an emergency
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* You have selected "NO' to one of the first 5 questions. Do not proceed with work until you can answer yes by putting controls in place. If in Doubt contact your Supervisor. ***YOU ARE NOT AUTHORISED TO BEGIN WORK****
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Controls are now in place
Assess for Potential Hazzards
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1-HAZARDOUS ENERGY ELECTRICAL - Do I need to isolate and test for Zero Energy State using LOTO and Volt Alert? ***For Security Systems under 50v DC ZES is not required***
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- Hazard Identified - Hazardous Electrical Energy. Scan, Assess, Fix, Execute: What effect could the hazard have on people property and the Environment
Hazardous Electrical Energy.
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Hazard Identified
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Controls you implemented to reduce the risk
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Safe to continue?
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Call your Supervisor for Assistance ***YOU ARE NOT AUTHORISED TO BEGIN WORK***
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I have called my Supervisor for advice and guidance
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Hazard Identified
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Controls you implemented to reduce the risk
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Hazard Identified
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2- HAZARDOUS ENERGY MECHANICAL - Can I be harmed by stored energy (water, gas under pressure) heat, fumes, chemicals?
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- Hazard Identified - Hazardous Mechanical Energy. Scan, Assess, Fix, Execute: What effect could the hazard have on people property and the Environment
Hazardous Mechanical Energy.
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Hazard Identified
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Controls you implemented to reduce the risk
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Safe to continue?
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Call your Supervisor for Assistance ***YOU ARE NOT AUTHORISED TO BEGIN WORK***
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I have called my Supervisor for advice and guidance
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3- FALL PROTECTION - Can I fall from height?
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- Hazard Identified - Working at Heights. Scan, Assess, Fix, Execute: What effect could the hazard have on people property and the Environments
Working at Heights.
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Hazard Identified
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Controls you implemented to reduce the risk
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Safe to continue?
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Call your Supervisor for Assistance ***YOU ARE NOT AUTHORISED TO BEGIN WORK***
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I have called my Supervisor for advice and guidance
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4- WORKING UNDER SUSPENDED LOADS - Am I concerned that something may fall on me or strike me?
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- Hazard Identified - Suspended Loads. Scan, Assess, Fix, Execute: What effect could the hazard have on people property and the Environment
Working Under Suspended Loads
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Hazard Identified
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Controls you implemented to reduce the risk
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Safe to continue?
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Call your Supervisor for Assistance ***YOU ARE NOT AUTHORISED TO BEGIN WORK***
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I have called my Supervisor for advice and guidance
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5- Could there be uncontrolled movement?
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- Hazard Identified - Uncontrolled Movement. Scan, Assess, Fix, Execute: What effect could the hazard have on people property and the Environment
Uncontrolled Movement
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Hazard Identified
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Controls you implemented to reduce the risk
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Safe to continue?
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Call your Supervisor for Assistance ***YOU ARE NOT AUTHORISED TO BEGIN WORK***
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I have called my Supervisor for advice and guidance
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6- GRAVITY - Can I slip or trip on anything?
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- Hazard Identified - Slips Trips and Falls. Scan, Assess, Fix, Execute: What effect could the hazard have on people property and the Environment
Gravity
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Hazard Identified
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Controls you have implemented to reduce the risk
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Safe to continue?
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Call your Supervisor for Assistance ***YOU ARE NOT AUTHORISED TO BEGIN WORK***
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I have called my Supervisor for advice and guidance
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7- MANUAL HANDLING - Can I strain or over exert myself?
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- Hazard Identified - Manual Handling . Scan, Assess, Fix, Execute: What effect could the hazard have on people property and the Environment
Manual Handling
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Hazard Identified
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Controls you have implemented to reduce the risk
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Safe to continue?
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Call your Supervisor for Assistance ***YOU ARE NOT AUTHORISED TO BEGIN WORK***
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I have called my Supervisor for advice and guidance
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8- LINE OF FIRE - Can I be caught in, on, or between anything?
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- Hazard Identified - Line of Fire. Scan, Assess, Fix, Execute: What effect could the hazard have on people property and the Environment
Line of Fire
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Hazard Identified
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Controls you have implemented to reduce the risk
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Safe to continue?
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Call your Supervisor for Assistance ***YOU ARE NOT AUTHORISED TO BEGIN WORK***
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I have called my Supervisor for advice and guidance
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9- Can I damage any equipment?
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- Hazard Identified - Damage to Equipment. Scan, Assess, Fix, Execute: What effect could the hazard have on people property and the Environment
Damage to Equiptment
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Hazard Identified
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Controls you have implemented to reduce the risk
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Safe to continue?
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Call your Supervisor for Assistance ***YOU ARE NOT AUTHORISED TO BEGIN WORK***
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I have called my Supervisor for advice and guidance
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10- Do I need to communicate to my workmates the risks associated with this task?
Communication
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What Needs to Be Communicated?
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How will this be communicated?
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Safe to continue?
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Call your Supervisor for Assistance ***YOU ARE NOT AUTHORISED TO BEGIN WORK***
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I have called my Supervisor for advice and guidance
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ENVIRONMENT - Is there a chance I could spill or pollute something?
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- Hazard Identified - Environment. Scan, Assess, Fix, Execute: What effect could the hazard have on people property and the Environment
11- Enviroment
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Hazard Identified
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Controls you have implemented to reduce the risk
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Safe to continue?
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Call your Supervisor for Assistance ***YOU ARE NOT AUTHORISED TO BEGIN WORK***
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I have called my Supervisor for advice and guidance
Complete
Thank you for Completing this Take 5! You can now undertake your task.
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Remember, if conditions change you will need to update this assesment